Pain after amputation: clinical trial of a possible new treatment
This research was completed on 31 December 2014
Published on 26 June 2012
Over 4,000 leg amputations are carried out each year in the UK.1 After surgery, many people suffer prolonged, severe pain, which can dramatically reduce quality of life, limit rehabilitation and lead to a permanent loss of mobility and independence. Dr Jonathan Thompson, of the University of Leicester, is leading a clinical trial of a new treatment to find out whether it can provide much-needed relief from pain, reduce disability and improve quality of life.
People who undergo surgery to have their leg amputated can suffer severe pain afterwards. “People can experience so-called ‘stump pain’, which comes from the wound site itself,” explains Dr Thompson. “Up to 70% of people also suffer ‘phantom limb pain’, which feels like it is coming from part of the leg that has actually been amputated.2-5 They may, for example, experience a burning or cramping pain in their foot, even though their foot is no longer there.”
Troublesome phantom limb sensations also occur. People may experience sensations such as itching, movement, pressure and sensitivities to heat and cold that feel like they are coming from the missing limb.
Phantom limb pain is particularly difficult to treat, with many sufferers relying on strong pain killers, such as morphine. These are not always successful and often cause significant side effects.
“Sadly, some people find their pain persists over the long term,” says Dr Thompson. “Although a good recovery is possible after amputation, persistent pain complicates rehabilitation, making it more difficult to use prosthetic limbs and regain mobility, limiting independence and the ability to work. Chronic pain can also cause depression, sleep deprivation, a reluctance to socialise and difficulties with everyday activities.”
What is the project trying to achieve?
Dr Thompson is leading a clinical trial of a technique that involves placing a small tube, called a catheter, directly alongside the major nerve of the leg (the sciatic nerve) during surgery and infusing a local anaesthetic, called levobupivacaine, for 4 days.
The team is assessing effects on stump pain, phantom limb pain and phantom limb sensations over the following year. They are also assessing morphine requirements immediately after surgery and long-term effects on mood, physical disability and quality of life.
Over eighty patients who have diseased blood vessels in the leg (a common reason for amputation) have been recruited to the trial and results are expected towards the end of 2012.
Coping with pain can be exhausting”, explains Dr Thompson. “An effective treatment that relieves pain after amputation might reduce people’s reliance on pain killers and boost their chances of using prosthetic limbs. Successful rehabilitation can improve people’s chances of regaining their mobility, returning to work and living independently. It can also boost self-esteem.”
What are the researchers’ credentials?
The project leader, Dr Jonathan Thompson, and the University of Leicester’s Department of Anaesthesia, Critical Care and Pain Management, where he is based, have a long and well-established track record of researching what causes pain and how to manage it. The study team includes anaesthetists, nurses, pain specialists and surgeons.
|Project Leader||Dr J Thompson BSc MB ChB MD FRCA FFICM|
|Location||University Department of Anaesthesia, Critical Care and Pain Management, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester LE1 5WW|
|Grant awarded||30 October 2008|
|Start date||1 December 2008|
|End date||31 December 2014|
|Acknowledgements||This project was generously funded by The Henry Smith Charity|
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